Handbook on Drowning
Since 1767, the Maatschappij tot Redding van Drenkelingen in Amsterdam, rewards succesful rescuers with this medal in bronze, silver or gold. The medal represents Charity leaning over a drowning victim and warding off Death as he wields his scythe.
Handbook
on Drowning
Prevention, Rescue, Treatment
With 87 Figures, 9 in Colour and 52 Tables
123
Joost J. L. M. Bierens MD PhD MCDM Professor in Emergency Medicine Department of Anesthesiology VU University Medical Center PO Box 7057
1007 MB Amsterdam The Netherlands
ISBN-10 3-540-43973-0 Springer-Verlag Berlin Heidelberg New York ISBN-13 978-3-540-43973-8 Springer-Verlag Berlin Heidelberg New York
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by Jan-Carel van Dorp
The board of Governors of the Maatschappij tot Redding van Drenkelingen is happy to introduce this congress book, the fruit of much effort in recent years of many devoted researchers in the fields of prevention, rescue and treatment of drowned people. It is a compilation of the results of their successful studies, as laid down during the World Congress on Drowning held in Amsterdam on 26–28 June 2002.
Background
Through the ages death by drowning, like so many other causes, was accepted as a part of life. Water brings life, water takes life; burial follows. It was not until the 17
thor even as late as the 18
thcentury that it became apparent that people could be effectively rescued by bystanders, that many seemingly dead drowning victims only died after burial and that some of them could have been saved from this fate had they received medical attention.
In Europe it was the so-called Age of Enlightenment, with changing attitudes towards fellow man and social initiatives underway, including the founding of charitable societies. At that time three noblemen in Amsterdam realised that too many victims who had fallen in the waters of Amsterdam were left to their fate and died. Hence, in 1767, they founded a society for the rescue of drowning victims, de Maatschappij tot Redding van Drenkelingen. Their initiative was widely applauded.
In the years that followed other cities in Holland started their own initiatives.
Great interest was shown by France, Russia, Austria, England, Switzerland and Denmark, as well as the cities of Venice, Hamburg and New York and similar foundations were created in some of these places.
Since its foundation the Maatschappij tot Redding van Drenkelingen has devoted itself to promoting everything that would lead to or improve the prevention, rescue and treatment of drowning victims. The means by which it has done this are discussed in the following sections.
Proclamations
Both the public and the authorities needed to be made aware of the duty to rescue
drowning victims and resuscitate them. Therefore, a publicity campaign was
started proclaiming that a drownee should be removed from the water, taken
indoors, rubbed and warmed. To this end, posters were hung around the city in
churches, coffee shops, beer shops and pubs.
Promotion of the Development of Resuscitation Methods
The methods of the time were crude, ranging from rolling the body over a barrel to inserting smoke in the intestines via the anus. Some people, however, realised at that time that more victims may have survived if these treatments had not been applied. Even worse was the fact that not much was known about the state of
‘apparent death’. This ignorance persisted right up until the beginning of the 20th century, and it would last until the middle of that century before the effectiveness of mouth-to-mouth resuscitation was recognized.
So for more than one and a half centuries victims were subjected to the old methods of being hung from their feet, tickled with a feather under the nose and in the throat or inflated with smoke before slowly more effective methods became known.
Rewarding Successful Rescuers
In order to encourage bystanders to intervene and help drowning victims, rewards were offered to successful rescuers in the form of either a sum of money or a medal. The sum of money was much coveted as a possible reward and many cases of gallant rescues were reported, although on closer scrutiny some appeared to be forged cases.
The medal was designed in 1767, the year of the foundation of the Maatschappij tot Redding van Drenkelingen (
⊡ Fig. 1). It shows a woman representing Charity leaning over a drowning victim and warding off Death as he wields his scythe.
The reverse side of the medal has room for a personalised inscription.
Present Activities
The Maatschappij tot Redding van Drenkelingen continued these activities till far into the 20
thcentury, first confined to the city of Amsterdam and later on expanding to the rest of the Netherlands.
It concentrates on the same three fields: publicity, research and awarding medals. Publicity comprises a variety of activities such as television adverts that are shown on prime time television, instruction stickers with pictures of the mouth-to-mouth resuscitation method that are widely distributed and
⊡ Fig. 1 Medal offered to rescuers of a drowning victim
VI Foreword
the yearly report containing a survey of the activities of the Maatschappij tot Redding van Drenkelingen. It is distributed to specific groups in the Netherlands such as watersports organisations, schools, municipalities, and swimming pool organisations.
The Maatschappij tot Redding van Drenkelingen supports students and researchers in their research activities on all matters within its scope. An example of a research project – in this case of significant size – supported by the Maatschappij tot Redding van Drenkelingen is the World Congress on Drowning.
Awarding medals is another important activity. Rescuers greatly appreciate being rewarded for their deeds. At the request of the Maatschappij tot Redding van Drenkelingen mayors confer the medals on recipients. The local press is usually present, which is a good way to spread the message. In its 235 years of existence the Maatschappij tot Redding van Drenkelingen has awarded medals in some 6770 cases of successful rescue.
In 1995, the anaesthesiologist Joost Bierens drew the attention of the Maatschappij tot Redding van Drenkelingen to the world-wide dimension of drowning, the need to further develop rescue methods, co-ordinate research and to aim for consensus in these fields. The need for this was indeed confirmed in a quick survey that year, undertaken by the Maatschappij tot Redding van Drenkelingen with experts in different disciplines in many countries. They almost unanimously applauded the idea of a World Congress on Drowning.
Thus in 1997, 230 years after its founding, the Maatschappij tot Redding van Drenkelingen undertook to organise the World Congress on Drowning 2002, the first of its kind. The reasons were clear: the immense number of drowning victims world-wide, the lack of research co-ordination in the different parts of the world and the need for a consensus on treatment.
The content of the congress was new with a multitude of disciplines, and therefore unlike the many existing congresses. It required an individual and innovative approach and constant designing, rethinking and adjusting.
Professionals in roughly ten different fields related to prevention, rescue and treatment were asked to organise task forces and to lead their task force members in assessing the situation in their fields. The members of the task forces were spread all over the world. For them e-mail proved the ideal mode of communication. In Holland a steering group was set up, each member being an expert and counterpart for a task force leader.
In 1999, 2000 and 2001 the task force leaders convened with the steering group in Amsterdam. Goals were set, mutual adjustments made, progress monitored and the modes and forms of presentation at the congress were discussed.
A website was opened: www.drowning.nl on which all results of the research were amassed and which has remained operational since the congress.
The PR advisors Hill and Knowlton set up a PR campaign in a score of
international magazines, as well as in the Dutch newspapers and on TV, which
promoted the congress very successfully.
VIII Foreword
Finally, on 26–28 June 2002 the World Congress took place in The RAI convention centre in Amsterdam, followed the day after by ”Dutch Day”. Some 500 people from around the world learned about the latest developments in their field, as well as in adjoining fields.
There were posters, plenary sessions and parallel sessions, an exhibition and a specialised bookshop. Many contacts were made and the congress book (which you now hold in your hand) was announced.
The Royal Netherlands Sea Rescue Institution (KNRM) organised workshops and a splendid demonstration on the North Sea coast. There were social events such as the reception held by the Mayor and Elders of the City of Amsterdam, a lively dinner event put on for congress visitors in the old West-Indisch House in the heart of the city.
Constant assessment of the results of the congress meetings resulted in provisional recommendations that were presented in the closing session on Friday afternoon 28 June 2002.
The results of the international congress were conveyed to the some 350 visitors of ”Dutch Day” on Saturday 29 June 2002; and there too satisfaction was expressed.
After reviewing the results of the congress the Board of Governors of the Maatschappij tot Redding van Drenkelingen, together with the steering group and the task force leaders, has come to the conclusion that a significant deepening of knowledge has been achieved in the fields of prevention, rescue and treatment.
Many institutions, as well as individuals, have each in their way contributed to the success of the congress and deserve a word of gratitude.
How to Proceed?
Although there is great satisfaction at what has already been achieved, it is now clear that we have only just started on the long path towards the necessary research and development.
We hope to receive suggestions on how to proceed and invite comments and ideas to be sent to the address of the Maatschappij tot Redding der Drenkelingen.
It is with gratitude to all those who contributed to it that we recommend this Handbook on Drowning.
The Board of Governors
Jan-Carel van DorpChairman Maatschappij tot Redding van Drenkelingen
by Prof. Dr. Johannes Knape MD PhD
Death by drowning is unexpected and unwanted in most cases and is as old as the world. Nevertheless death by drowning was considered by many to be inevitable, the consequences of drowning to be irreversible and drowning itself in some cultures to be an act of a Higher Power. This attitude has discouraged people and even put them off taking initiatives to explore potential alternative approaches to drowning, as has been the case with sudden cardiac death for a long time.
But times have changed. The first society in the world active in the field of trying to improve the outcome of drowning victims, de Maatschappij tot Redding van Drenkelingen (The Society to Rescue People from Drowning), was established in Amsterdam in 1767. Other societies, such as the Royal Humane Society in London, England, soon followed this example. The growing realisation that human initiatives and activities of various kinds could result in a reduction in the number of drowning victims caused rescue societies to be set up and scientific attention on the problem of drowning from various sources to increase.
The (re-)invention of effective resuscitation techniques by the late Peter Safar (1924–2003) in 1960 meant a revolution in the prospects of victims of sudden cardiac arrest. The scientific activities which Safar and his group developed has also caused an upturn in interest in drowning victims. It seems that the same may hold true for drowning as for cardiac arrest victims and that better prospects are on the horizon. To quote Safar: ”it is great when we can arrange death to come back later”.
Thus many disciplines felt that a lot of progress had been made for drowning victims in the last decades of the 20th century. On the other hand it was surprising that research papers on the subject of drowning were scarce and that research meetings in this field were few. It was not surprising then that, in 1995, the oldest society in the field of drowning in the world, the Maatschappij tot Redding van Drenkelingen, took the initiative to organise a meeting where experts on all aspects of drowning (epidemiology, prevention and innovation in technology, rescue, resuscitation, medical aspects, hypothermia, water-related disasters and diving) could meet and discuss these issues.
The World Congress on Drowning, which was held in Amsterdam in 2002 for the first time, gathered hundreds of world experts from various fields of expertise to speak, listen, discuss and learn from one another.
This Handbook on Drowning is the first ever compilation of knowledge on drowning. It has been written by a great number of the experts at the World Congress, by the various task forces, as well as other individuals.
It is unique in that it also contains the documents which were the result
of the various consensus meetings during the World Congress and the final
X Foreword
recommendations of the World Congress on Drowning. It has become a unique state of the art document on drowning today.
The authors, section editors and the editor, Professor Joost Bierens, sincerely hope that the contents of this book will inspire the reader to be increasingly creative in preventing drowning and in improving the chances for drowning victims in the future. If this handbook manages to prevent one case of death due to drowning, then its making was worthwhile. It is the conviction of the authors of this book that far greater progress in the improvement of the fate of drowning victims is possible due to the efforts of many.
Prof. Dr. Johannes Knape MD PhD
Chairman of the Foundation Drowning 2002 and of the scientific steering group
World Congress on Drowning
by Margie Peden PhD
It is estimated that nearly 400,000 people drowned worldwide in 2002, making it the second leading cause of unintentional death globally after road traffic crashes. The overwhelming majority of these drowning deaths occurred in low- and middle-income countries. In fact, China and India alone accounted for just over 40% of all the drowning deaths. Data on non-fatal drowning morbidity is hard to estimate since these data are not available in many low- and middle- income countries.
Among the various age groups, children under 5 years of age have the highest drowning mortality rates worldwide. Some other major risk factors include alcohol consumption while swimming, boating, fishing, floods, uncovered water wells, transportation in unsafe or overcrowded vessels and epilepsy. Access to water is obviously the most important risk factor for drowning.
Drowning, however, can be prevented. There are many interventions which have been evaluated in high income countries but few have been tested in the developing world. Nevertheless, the four main principles for drowning prevention remain the same: remove the hazard, create barriers, protect those at risk and counter the damage. Further research on interventions in developing countries is urgently required and public health professionals have a major role to play in most of these prevention activities. The WHO constitutional mandate, as the leading co-ordinating agency for international public health, places it in a unique position to guide a science-based programme of activities in drowning prevention.
WHO has been concerned with the health aspects of water and water supply for many years through its department of Sustainable Development and Healthy Environments. Of particular concern has been the management of recreational waters which is one aspect of drowning prevention. To this end the WHO issued Guidelines for Safe Recreational Waters in 2003 which includes a chapter on drowning prevention. Furthermore, the Department of Injuries and Violence Prevention at WHO has recently begun to look at the issue of drowning prevention, particularly in low- and middle-income countries, and raising general awareness about the problem. WHO Injury Surveillance and Survey Guidelines will guide less-resourced countries to assess the magnitude of their injury problem, including that of drowning.
Human resources in the area of drowning prevention are few and far between,
particularly in developing countries. The time to act is now. We all need to
work together to prevent drowning worldwide. WHO therefore compliments the
organisers of the First World Congress on Drowning, held in the Netherlands in
June 2002, for bringing together experts in the field, developing a standardised
XII Foreword
definition for drowning and for subsequently developing this Handbook on Drowning which gathers together all that we know about the epidemiology, prevention and advocacy of this neglected epidemic.
Margie Peden PhD
Coordinator Unintentional Injuries Prevention
Department of Injuries and Violence Prevention World Health Organization
by B. Chris Brewster
The International Life Saving Federation (ILS) is driven by a mission to en- hance the safety and preservation of human life in the aquatic environment. We were extremely pleased to collaborate with the Maatschappij tot Redding van Drenkelingen in the tremendously successful effort to convene the historic World Congress on Drowning 2002. This was a seminal event that established critical benchmarks in drowning prevention procedures, as well as setting a course for future improvements to further our trademark goal: World Water Safety. This confluence of purpose of so many scholarly people, like the joining of streams into a mighty river, will unquestionably benefit all the people of the world.
ILS endeavours to lead the worldwide effort to reduce injury and death in, on, and around the water. Through ILS and our member federations, lifesav- ing research, development, education, and rescue information is generated and disseminated globally. We continually work to advocate with national govern- ments and non-governmental organisations to establish drowning as a public safety issue. We advance lifesaving and drowning prevention by co-ordinating and facilitating the work of national lifesaving organisation, facilitating infor- mation exchange through research and dissemination of best practice, working with member organisations to establish and support lifesaving organisations in geographic areas where they do not exist, developing lifesaving by acting as the international federation for lifesaving sport, and by co-operating with other in- ternational bodies with shared goals.
The greatest value of the World Congress on Drowning 2002 is leadership to- ward identifying obstacles to water safety and proposing steps to remove them.
The International Life Saving Federation will continue our ongoing leadership in this area, including taking action to implement recommendations made at the congress. We have now established a Lifesaving Commission composed of a rescue committee, education committee, medical committee, development com- mittee, and drowning report committee. This commission is well prepared to address major recommendations of the World Congress on Drowning.
Since the congress, ILS has adopted the new definition of drowning and has fulfilled another of the congress recommendations by publishing international beach safety warning flag standards. The ILS rescue committee already serves as a forum for investigating and validating the efficacy of rescue techniques. This committee is now working on development of international beach safety sign standards. The rescue committee will also further congress recommendations on use of personal watercraft in rescue, optimal visual scanning techniques, and use of the incident command system in aquatic rescue.
Through our education committee, ILS intends to serve as the world body for
teachers of water safety and swimming, emphasizing the value of these skills to
XIV Foreword
all the people of the world. The education committee will evaluate the use of ILS training guidelines to promote the wearing of lifejackets to prevent drowning.
ILS embraces the congress recommendation of teaching basic resuscitation skills to rescuers and lay persons. Through the co-ordination of our development committee, ILS is continually helping increase the number of lifesaving organisations throughout the world, while our education committee identifies best practice training standards for new and existing lifesaving organisations. As recommended at the congress, our standards call for all lifesaving organisations to include basic resuscitation skills for all participants. ILS member lifesaving federations can also help further the congress recommendations of helping encourage a balance between safety and profitability of recreational diving, as well as promoting the safety of diving fishers.
The World Congress on Drowning was the most impressive gathering of medical personnel focussed on drowning and water related injury in the history of lifesaving. Through the ILS medical committee, medical system organization which was recommended to improve drowning process outcomes will be encouraged and the results will be critically appraised for educational purposes.
New medical terminology recommendations will also be encouraged through ILS medical committee leadership and within our member organizations. Several ILS medical position statements will be forthcoming to further the recommendations of the congress, including those related to spinal immobilisation techniques.
As suggested by the World Congress on Drowning, ILS intends to develop the World Drowning Report to facilitate uniform reporting of drowning cases through a single international source of data registration, both from developing and developed nations. The ILS World Drowning Report will also encourage adoption of standardised definitions, as suggested at the Congress.
In summary, the International Life Saving Federation embraces the opportunity to utilise the progress made at the World Congress on Drowning 2002 to advance the cause of drowning prevention throughout the world. We commend the organisers and commit ourselves to fulfilling the ultimate goal of the congress: worldwide drowning prevention.
B. Chris Brewster
Chairman of the ILS Lifesaving Commission
by Peter B. Bennett PhD DSc
A few years ago I was invited to speak at a meeting in Florida on scuba diving safety and accidents. It was concentrated around a pressure chamber for recompression of divers stricken with decompression sickness, or the “bends”.
Conjointly there was a display with brochures and coloring books for small children organized by local volunteers on drowning. It concentrated on trying to make the general public, and especially those with swimming pools, aware of the dangers of drowning and, as far as possible, how to avoid this risk and what to do in a drowning emergency.
With some 9000 drownings in the US per year, it became very clear to me that there was simply insufficient awareness of this problem among the public. This was compounded for me by the fact that the 100 deaths in the US per year from scuba diving are usually primarily listed as ‘drowning’ by coroners in conjunction with other diving hazards.
The Divers Alert Network (DAN), a non-profit diving safety association, provides a great deal of education on what to do in scuba diving emergencies and first aid. This includes giving 100% oxygen and possibly the use of automated external defibrillators (AED). DAN has extensive international training schemes in this area.
Very often, in swimming pool drownings, among others, it may take over 30 minutes for an emergency team to arrive. During that time, if the individual is not breathing, it will be too late. After a period of some 4 minutes it becomes progressively more difficult to achieve a recovery unless the victim has been in very cold water.
Clearly, to my thinking, it would be a good idea for individuals with swimming pools, or owners of boats to have a course on emergency oxygen and AED use so that they can provide vital emergency first aid before the professional teams arrives.
It was these thoughts that drove me to stimulate the interest of the International Divers Alert Network to support this Congress on Drowning.
Although I have since retired, I hope that others will take up the concept and concentrate on a broad program of education to help prevent drowning and, if it does happen, how to provide emergency care.
Peter B. Bennett PhD DSc
Founder, Former President DAN America Emeritus Chairman International DAN Professor of Anesthesiology
Duke University Medical Center
Introduction
This is a unique book for those involved in aquatic incidents and, more specifically, for those involved in one way or another with drowning incidents.
Although some books on drowning have been published, this book serves a well- defined cause: to reduce the number of drownings and to improve outcome in drowning victims.
The book is the culmination of a process that started in Amsterdam in 1996 on the initiative of the Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning, established in 1767) and has involved several hundred experts who came together at the World Congress on Drowning held in May 2002. During that congress these experts, from a wide variety of different backgrounds and specialties, held interactive sessions. It is this active participation and multidisciplinary co-operation that makes this book unique.
For example, some authors have practical lifelong experience with aquatic emergencies, but have never written about their expertise before. Others are experts in a particular field of research related to the issue of drowning, but have hardly ever enjoyed (or have even feared) one of the many activities associated with water. Thus, practical down-to-earth information is combined with latest scientific data.
Because of this level of collaboration there may be some overlap or contradiction of information in some of the chapters, and not all sections will be of practical use for all readers. However, all readers will undoubtedly find a lot of information that is relevant for them within the 12 sections. Even though some sections may be less applicable to their field of involvement, this information may serve to emphasise that their involvement in the prevention, rescue or treatment of drowning is only one part of a worldwide process and that collaboration with other partners on a local, national and international level is worthwhile and often even essential.
Although the authors come from all over the world it is unfortunate that the low-income areas, where most drownings occur, are underrepresented.
This fact confronts us with the greatest challenge at the moment: how can we
involve the low-income countries in the struggle against drowning, not instead
of grappling with other major political, social and economic problems, but in
addition to these struggles? International organisations such as the World Health
Organisation (WHO), the International Maritime Organisation (IMO), the
International Life Saving Federation (ILS), the International Life Boat Federation
(ILF), the International Red Cross and Red Crescent Societies (IRCRCF) and the
Divers Alert Network (DAN) will hopefully find ways to work together to combat
drownings in low-income countries.
The 2004 tsunami in Asia with tens of thousands of deaths, most of them by drowning, has resulted in an increased global awareness of the unpredictable and devastating power of water. All those who are familiar with the aquatic environment already knew this and may even have experienced this themselves.
Although the tragedy in Asia was on an unprecedented scale and caused immeasurable sadness, the total number of drowning victims each year worldwide is about three times that of the 2004 tsunami disaster. This immense number refers to individual drowning, without public media coverage, but resulting in the same intensity of grief and pain for those who remain behind. If the information in this book stimulates actions that would reduce even 1% of all drownings each year, and help to prepare for future aquatic catastrophes, this means that our joint efforts would already save thousands of lives each year.
Summarised below are the main items to be found in this book.
Section 1 covers some historical elements: the history of the initiating body (the Maatschappij tot Redding van Drenkelingen), the development of faster and safer lifeboats, the role that drownings have played in the very first developments of resuscitation, and an overview of the projects related to the World Congress on Drowning. The final chapter in Section 1 will bring back good memories to those involved, and gives others a realistic impression of the work being done.
Section 2 presents extensive epidemiological data from around the world. At the time these data were collected for the World Congress on Drowning, this was the first attempt to gain a global overview of the problem and since then, also stimulated by the World Congress on Drowning, several other new initiatives have taken place to improve data collection. The new, more practical, definition of drowning will be of great importance in the endeavour to generate more complete and reliable worldwide data.
In Section 3 several options for drowning prevention strategies are summa- rized. It became clear to all participants that the drowning process evolves very quickly and that death can occur in just a few minutes. Therefore, prevention will be the most effective approach to reduce the number of drownings. To achieve this, a permanent multi-focus approach of combined organisations is needed.
The organisational aspects of rescue are addressed in Section 4, while the practical aspects of rescue are covered in Section 5. Both sections give an extensive overview of what is happening in the area of water rescue. Although these rescues may differ greatly depending on the location ( for example swimming pool, river, ocean), the developments occurring at one place may still be of practical use in other areas. It is noteworthy that as a result of the congress the international exchange of information, experiences, projects and research increasingly takes place in the pragmatic and practical arena.
The following five sections deal with medical aspects. Initially, it was assumed
that the medical aspects would be the main focus of this project. However, soon
after the project started, it became clear that prevention and rescue are more
important in reducing the number of drownings than the medical care given af-
ter the victim is taken out of the water. Nevertheless, having medical aspects as
the initial focus for the project meant that many medical experts were prepared
to contribute their expertise and a wide variety of medical issues could be de-
Introduction XIX
scribed from different viewpoints. The medical aspects therefore still represent the majority of themes in the book. Section 6 addresses several resuscitation top- ics, and highlights the fact that drowning can only be survived when the imme- diate bystander starts with resuscitation. This section also includes a chapter on the Utstein-style guidelines for the registration of drowning which, when used in future studies, will help to better understand the resuscitation of drowning.
Section 7 deals with several aspects of the treatment of drowning victims in the hospital setting. Experts in emergency and intensive care treatment, as well as specialists in circulatory and respiratory problems, indicate which therapies are preferred.
The extrapolation of current knowledge on hypoxic brain damage to the specific situation of the drowning victim is the focus of Section 8. The information provided offers a unique scholarly background in the understanding and treatment of the often severe neurological complications after drowning.
Section 9 offers a combination of scientific and practical information on immersion hypothermia. Drowning by immersion occurs by means of a mechanism other than submersion. This section reviews the pathophysiological and practical consequences.
Section 10 addresses water-related disasters. The impact of such disasters is now painfully evident, but at the time this project started, few were so acute- ly aware of the extent of the potential disaster of water and the related risks of drowning. In view of the very latest knowledge concerning the 2004 tsunami, and the 2005 floods in Louisiana caused by hurricane Katrina, some chapters may have been written with a different perspective. Nevertheless, this section still provides an important theoretical basis for the actions that need to be taken to reduce the risk of drowning as a result of water-related disasters.
In Section 11 the results of a joint effort by the world’s leading medical divers are summarized. The section covers prevention, rescue and treatment of the drowned diver and includes some important recommendations for future initiatives.
Several aspects of the drowning victim who has not survived are dealt with in Section 12. Although this particular area was not originally considered when preparing the project, it became clear that a lot of expertise is available on the search procedures, forensic aspects and jurisdiction related to persons who died by drowning.
For me, as project co-ordinator of the project World Congress on Drowning
and co-ordinating editor of this Handbook on Drowning Rescue, Prevention
and Treatment, it was a challenge to keep track of the continuous developments
related to the dynamics of the project, and a great privilege to work with
such an outstanding and dedicated group over several years. I consider their
commitment, support and comradeship to be the most important reasons why
the initiative, taken by a small national organisation, has become a worldwide
success. The members of the steering group in the Netherlands, the international
group of task force leaders, as well as each individual task force member were
particularly important in the steps toward the World Congress on Drowning held
in Amsterdam in 2002, and in the publication of this book in 2005.
This book marks the end of a period spanning three decades between my first day as a lifeguard on one of the most remote beaches in the Netherlands, and the worldwide upgrading of all available knowledge in the field of drowning prevention, rescue and treatment as a professor in Emergency Medicine. As such, this book is for me an acknowledgement of my emotional links with the sea and the resulting intellectual challenges to find a way to tackle the problem of drowning. Most of the work towards achieving this has been done by the hundreds of volunteers who, one way or another, have contributed to the process.
I will be grateful to each of them for the rest of my life. This book is a tribute to them, their families, their loved ones, and to those they sadly lost by drowning.
My special thanks go to the three board members of the Foundation Drowning 2002, Hans Knape, chairman of the scientific steering committee, Rutger Count Schimmelpenninck, chairman of the Maatschappij tot Redding van Drenkelingen during the course of the project, and vice-admiral retired of the Royal Netherlands Navy, former Commander-in-Chief, Herpert van Foreest esq. Their continuing support and input kept the process going.
The book is published as a tool that will further reduce the number of drownings and improve the outcome. This means that the readers are challenged not only to read this book and put the information into practice, but also to co-ordinate local, regional, national or international initiatives in their own fields of expertise, competencies and jurisdiction. In this way the snowball will continue to roll and become even larger.
The future activities observed throughout the world may well be a reason for the Maatschappij tot Redding van Drenkelingen to start a second initiative under their patronage.
Joost J. L. M. Bierens MD PhD MCDM
Contents
Foreword V Introduction XVII
Section 1 History 1
Section editor: Joost Bierens
1.1 Brief history of Maatschappij tot Redding van Drenkelingen (The Society to Rescue People from Drowning) 3
Balt Heldring
1.2 Two Centuries of Searching for Safe Lifeboats 5 Hans Vandersmissen and Ton Haasnoot 1.3 The History of Resuscitation 14
Bart Jan Meursing
1.4 The World Congress on Drowning: A Move Towards the Future 21 Joost Bierens and Hans Knape
Section 2
The Epidemiology of Drowning 39
Section editors: Christine Branche and Ed van Beeck 2.1 Overview 41
Christine Branche and Ed van Beeck 2.2 Recommendations 43
The Task Force on the Epidemiology of Drowning:
Christine Branche, Ed van Beeck, Olive Kobusingye, John Langley, Ian Mackie (†), Eleni Petridou, Linda Quan, Gordon Smith and David Szpilman
2.3 Definition of Drowning 45
Ed van Beeck, Christine Branche, David Szpilman, Jerome Modell and Joost Bierens
2.4 Methods for Estimating the Burden of Drowning 49
Linda Quan
2.5 Availability and Quality of Data to Assess the Global Burden of Drowning 54
Ian Mackie (†)
2.6 The Global Burden of Drowning 56 2.6.1 The Global Burden of Drowning 56
Gordon Smith
2.6.2 The Global Burden of Drowning: An African Perspective 61 Olive Kobusingye
2.7 Risk Factors for Drowning 63
Eleni Petridou and Alexandra Klimentopoulou 2.8 Review of Literature on Available Strategies
for Drowning Prevention 70 John Langley
2.9 Occupational Drownings 73 Jennifer Lincoln
Section 3
The Prevention of Drowning 77
Section editors: John Wilson, Hans Knape and Joost Bierens 3.1 Overview 82
John Wilson and Wim Rogmans 3.2 Recommendations 84
Wim Rogmans and John Wilson
3.3 Purposes and Scope of Prevention of Drowning 87 John Wilson and Wim Rogmans
3.4 Risk Assessment and Perception 93 Andrej Michalsen
3.5 Prevention of Drowning in the Home and Garden 99 John Pearn and David Calabria
3.6 Prevention of Drowning in Home Pools 105 Ian Scott
3.7 The Vigilance of Beach Patrols 110 Andrew Harrell
3.8 Swimming Abilities, Water Safety Education and Drowning Prevention 112
Ruth Brenner, Kevin Moran, Robert Stallman,
Julie Gilchrist and John McVan
3.9 National and Community Campaigns 117
Elizabeth Bennett (coordinating author), Peter Barss, Peter Cornall, Katrina Haddrill, Rebecca Mitchell, Laurie Lawrence, John Leech, Marilyn Lyford, Kevin Moran, Luis-Miguel Pascual-Goméz, Paloma Sanz, Blanca Barrio, Santiago Pinto, Frank Pia, Linda Quan, Monique Ridder, Marcia Rom, Greg Tate and Andrew Whittaker
3.9.1 National Surveillance-Based Prevention of Water-Related Injuries in Canada 117 Peter Barss
3.9.2 Child Drowning Deaths in Garden Water Features − A Concerted Campaign to Reduce the Toll 119 Peter Cornall
3.9.3 SafeWaters Water Safety Campaign in New South Wales, Australia 120
Katrina Haddrill and Rebecca Mitchell 3.9.4 Community Campaign in Australia
Targeted Towards Parents and Children 121 Laurie Lawrence
3.9.5 The Approach to Promoting Water Safety in Ireland 122 John Leech
3.9.6 Community Campaign in Remote Aboriginal Communities in Western Australia 123
Marilyn Lyford
3.9.7 Community Campaigns in New Zealand 124 Kevin Moran
3.9.8 Community Campaigns Blue Ribbon Pool
and Enjoy Your Swim, Sure! in Segovia, Spain 125 Luis-Miguel Pascual-Gómez, Paloma Sanz, Blanca Barrio and Santiago Pinto
3.9.9 The Reasons People Drown 126 Frank Pia
3.9.10 Washington State Drowning Prevention Project and the Stay on Top of It Campaign 127 Linda Quan and Elizabeth Bennett 3.9.11 Community Campaign in the Netherlands
by the Consumer Safety Institute 128 Monique Ridder
3.9.12 Preventing Drowning in Alaska: Float Coats and Kids Don’t Float 129
Marcia Rom
3.9.13 Evaluation of the Keep Watch Media Campaign 130 Greg Tate
3.9.14 Community Campaign in Victoria, Australia 131 Andrew Whittaker
Contents XXIII
Section 4
Rescue - Organisational Aspects:
Planning, Training and Preparation 133 Section editors: Rob Brons and Chris Brewster 4.1 Overview 135
Chris Brewster and Rob Brons 4.2 Recommendations 138
Chris Brewster and Rob Brons
4.3 Rescue Organisations: Paid or Volunteers? 142 Mike Espino and Chris Brewster
4.4 Lifeguard Effectiveness 145 Ralph Goto
4.5 Quality Assessment and Risk Monitoring of Lifesaving 147 Rob Brons
4.6 Beach Hazards and Risk Assessment of Beaches 151 Andrew Short
4.7 Training Standards for In-Water Rescue Techniques 156 Rick Wright
4.8 Training and Equipping Rescue Personnel for Flood Rescue 159 Slim Ray
4.9 Learning from Computer Simulations 162 Wiebe de Vries
4.10 Data Registration for Lifesaving Organisations 168 Ann Williamson and Julie Gilchrist
4.11 Risk Management in Training of Rescue Techniques 172 Richard Ming Kirk Tan
4.12 Life Saving as an Academic Career: International Perspectives 176 Veronique Colman, Stathis Avramidis,
Luis-Miguel Pascual-Gómez,
Harald Vervaecke and Ulrik Persyn 4.13 Fund-Raising for Lifesaving 183
Klaus Wilkens
4.14 Lifesaving in Developing Countries 185
Margie Peden and John Long
Section 5
Rescue – Rescue Techniques 189
Section editors: Chris Brewster and Rob Brons 5.1 An Overview 194
Chris Brewster and Rob Brons 5.2 Recommendations 197
Chris Brewster and Rob Brons 5.3 Patterns of Wave and Surf 202
Edward Zwitser
5.4 Water Safety Signs and Beach Safety Flags 204 Brian Sims
5.5 Lifeguard Surveillance and Scanning: Past, Present, Future 214 Peter Fenner, Tom Griffiths,
Michael Oostman and Frank Pia
5.6 Trends in Sea Rescue and Open Water Search Techniques 220 Michael Woodroffe and Gabriel Kinney
5.7 Lifejackets and Other Lifesaving Appliances 226 5.7.1 Lifejackets 226
Chris Brooks, Günther Cornelissen and Rolf Popp 5.7.2 Personal Lifesaving Appliances Other than Lifejackets 229
Ivar Grøneng 5.8 Self-Rescue 232
5.8.1 Self-Rescue During Accidental Cold Water Immersion 232 Michel Ducharme
5.8.2 Survival and Self-Rescue 235 Anthony Handley
5.9 Submerged Vehicle Rescue 238 Jaap Molenaar and John Stoop
5.10 Horizontal and Other Rescue Techniques: Practical Aspects 241 Wolfgang Baumeier and Michael Schwindt
5.11 Ice Rescue 249
Carla St-Germain and Andrea Zaferes 5.12 Rescues Under Difficult Circumstances 254
5.12.1 Plane Crashes 254 Martin Nemiroff
5.12.2 Offshore Powerboat Rescues 256 Joost Van Nueten
5.12.3 The NASA Ocean Rescue Plan for the Space Shuttle 261 Ahamed Idris
Contents XXV
5.13 Rigid Inflatable Boats 264
Hans Vandersmissen and Ton Haasnoot 5.14 Inshore Inflatable Rescue Boat Injuries
with Implications for New Designs 271 Peter Fenner
5.15 Development and Use of Personal Watercraft in Aquatic Rescue Operations 275
Jim Howe
5.16 Alternatives for Rescue Boats 279 5.16.1 Hovercraft 279
Michael Vlasto 5.16.2 Jet Boat 284
Peter Dawes 5.16.3 Paraglider 286
Ruy Marra
5.17 Spinal Injury: Prevention, Immobilisation
and Extrication from the Aquatic Environment 288 5.17.1 Prevention of Spinal Injuries 288
Jenny Blitvich
5.17.2 Immobilisation and Extraction of Spinal Injuries 291 Peter Wernicki, Peter Fenner and David Szpilman 5.18 Injuries to Lifesavers 296
Peter Wernicki and Peter Fenner
5.19 Management of Physical and Psychological Responses During Administration of CPR to a Drowned Person 301 Frank Pia
5.20 Psychological Care After CPR and Rescue 304 Ton Haasnoot
Section 6
Resuscitation 309
Section editors: Paul Pepe and Joost Bierens 6.1 Overview 312
Paul Pepe and Joost Bierens
6.2 Consensus and Recommendations 314 Paul Pepe and Joost Bierens
6.3 The Critical Role of Lay Persons
and Their Actions in Drowning Incidents 323
Jane Wigginton, Paul Pepe, Denise Mann,
David Persse and Paul Sirbaugh
6.4 Basic Life Support for Drowning Victims 327 Ahamed Idris
6.5 Automated External Defibrillators in the Aquatic Environment 331 Steve Beerman and Bo Løfgren
6.6 Positioning the Drowning Victim 336 David Szpilman and Anthony Handley
6.7 First Aid Courses for the Aquatic Environment 342 David Szpilman, Luis Morizot-Leite, Wiebe de Vries, Justin Scarr, Steve Beerman, Fernando Martinho, Luiz Smoris and Bo Løfgren
6.8 Advance Life Support 348 Volker Wenzel and Paul Pepe
6.9 Long QT Syndrome and Drowning 352 Alfred Bove and Rienke Rienks
6.10 Paediatric Considerations in Drowning 356
Robyn Meyer, Andreas Theodorou and Robert Berg 6.11 Termination of Resuscitation Efforts in Drowning 363
Martin Nemiroff and Paul Pepe
6.12 Unusual Circumstances of Drowning 368 Peter Morley
6.13 A Case Report of an Extreme Situation 372 Martin Stotz and Wolfgang Ummenhofer 6.14 A Case Report of a Successful Resuscitation
from Accidental Hypothermia of 22°C and Submersion with Circulatory Arrest 374 Gert-Jan Scheffer
6.15 A Case Report of 22-Minute Submersion in Warm Water Without Sequelae 375
David Szpilman
6.16 Recommended Guidelines for Uniform Reporting of Data from Drowning: The Utstein-Style 377
Ahamed Idris, Robert Berg, Joost Bierens, Leo Bossaert, Christine Branche, Andrea Gabrielli, Shirley Graves, Anthony Handley, Robyn Hoelle, Peter Morley, Linda Papa, Paul Pepe, Linda Quan, David Szpilman, Jane Wigginton and Jerome Modell
Contents XXVII
Section 7
Hospital Treatment 387
Section editors: Harry Gelissen, Jean-Louis Vincent and Lambert Thijs 7.1 Overview 389
Harry Gelissen, Jean-Louis Vincent and Lambert Thijs 7.2 Recommendations 391
Harry Gelissen, Jean-Louis Vincent and Lambert Thijs 7.3 Treatment Protocols: Emergency Room 392
Antony Simcock
7.4 Treatment Protocols: Intensive Care Department 397 Walter Hasibeder, Volker Wenzel and Antony Simcock 7.5 Paediatric Considerations 402
Hans van Vught, Nigel Turner, Nicolaas Jansen and Sjef van Gestel 7.6 Aspiration 407
Jerome Modell
7.7 Management of ARDS 410
Davide Chiumello, E. Carlesso and Luciano Gattinoni 7.8 Risk Factors and Treatment of Pneumonia 416
Giel van Berkel 7.9 Surfactant Therapy 419
Jack Haitsma and Burt Lachmann 7.10 Cardiovascular Changes 423
Jerome Modell, Tomasso Pellis and Max Harry Weil 7.11 Classification Systems 427
David Szpilman, Antony Simcock and Shirley Graves
Section 8
Brain Resuscitation in the Drowning Victim 433 Section editors: David Warner and Johannes Knape 8.1 Overview 435
David Warner and Johannes Knape 8.2 Consensus and Recommendations 436
David Warner and Johannes Knape
8.3 Prehospital and Emergency Department Management of the Drowning Victim 439
Laurence Katz
8.4 Intensive Care Management of the Drowning Victim 443 Udo Illievich
8.5 Paediatric Considerations 447 Patrick Kochanek
8.6 Neuromonitoring in the Intensive Care Unit for the Drowning Victim 449
Cor Kalkman
8.7 Neurochemical Markers of Brain Injury 453 Bengt Nellgård
8.8 Post-hypoxic Treatment with Pharmacologic Agents 455 Takefumi Sakabe
8.9 Animal Experimentation on Cardiopulmonary Cerebral Resuscitation Relevant for Drowning 460 Peter Safar (†)
8.10 Future Research Questions 465 David Warner
Section 9
Immersion Hypothermia 479
Section editors: Beat Walpoth and Hein Daanen 9.1 Overview 481
Beat Walpoth and Hein Daanen 9.2 Consensus and Recommendations 484
Beat Walpoth and Hein Daanen
9.3 The Physiology of Cooling in Cold Water 485 Mike Tipton and Frank Golden
9.4 Body Cooling, Modelling and Risk Assessment 490 Peter Tikuisis and Hein Daanen
9.5 Rescue Collapse Following Cold Water Immersion 493 Michael Tipton and Michael Ducharme
9.6 Prehospital Management of Immersion Hypothermia 497 Michael Ducharme, Alan Steinman
and Gordon Giesbrecht
9.7 Hospital Rewarming of Hypothermic Victims 502 Durk Zandstra
9.8 Hospital Treatment of Victims in Cardiorespiratory Arrest 511 Beat Walpoth and Adam Fischer
Contents XXIX
9.9 Fluid Management During Treatment of Immersion Hypothermia 514 Marit Farstad and Paul Husby
9.10 Acid–Base Management During Accidental Hypothermia 519 Durk Zandstra
9.11 An International Data-Registration
for Accidental and Immersion Hypothermia 520
9.11.1 Implication of Treatment and Outcome of Survivors of Accidental Deep Hypothermia:
The Need for a Hypothermia Registry 520 Beat Walpoth
9.11.2 The UK National Immersion Incident Survey (UKNIIS) 521 Mike Tipton
9.11.3 Hypothermia Research Project in The Netherlands 523 Joost Bierens
9.11.4 The SARRRAH Project 524 Wolfgang Baumeier
Section 10
Water-Related Disasters 533 Editors: Rob Brons and Joost Bierens 10.1 Overview 535
Rob Brons and Joost Bierens
10.2 Consensus and Recommendations 539 Rob Brons and Joost Bierens
10.3 Disasters at Sea 540 Helge Brandstrom
10.4. ‘Herald of Free Enterprise’ 546 Karel Vandevelde
10.5 Decision Support System for Optimising a SAR Fleet Plan to Rescue Large Numbers of Passengers 548
Sip Wiebenga
10.6 Linking Sea and Land: Essential Elements in Crises Decisions for Water-Related Disasters 553
Martin Madern and Rob Brons
10.7 Drowning in Floods: An Overview of Mortality Statistics for Worldwide Floods 559
Bas Jonkman
10.8 Measures to Prevent The Netherlands from Flooding 565
Joop Weijers, Robert Slomp and Sjaak Poortvliet
10.9 Controlling the Risk of Flood-Related Drowning 568 Sjaak Poortvliet
10.10 The Safety Chain During Floods 570
Martin Madern, Rob Brons and Amanda Kost 10.11 Planning of the Mass Emergency Response to Floods
in the Netherlands 575
Pieter van der Torn and Bas Jonkman 10.12 Current Trends in Swift Water, Moving Water
and Flood Rescue Response 580 Jim Segerstrom
Section 11
Breath-Hold, SCUBA and Hose Diving 587 Section editors: David Elliott and Rob van Hulst Authors: Alfred Bove, Jim Caruso, Glen Egstrom, David Elliott, Des Gorman, Rob van Hulst, Maida Taylor and Jürg Wendling
11.1 Overview and Recommendations 589
11.2 The Underlying Physics and Applied Physiology 591 11.3 Diving Techniques 595
11.4 Epidemiology of Drowning While Diving 596 11.5 Physical, Mental and Medical Fitness 597
11.6 Causation of Drowning Accidents in Relation to Training 598 11.7 Introducing Children to Diving 599
11.8 Underwater Self-Rescue and Assisted Rescue:
Training to Cope With Emergencies 600
11.9 Immediate Treatment of the Diver Who Almost Drowned 601 11.10 Accident Investigation and Autopsy 603
11.11 Diving Accident Investigations 603
11.12 The Investigation of SCUBA Diving Fatalities 605
Section 12
Investigation of Drowning Accidents 617 Section editor: Jerome Modell
12.1 Introduction and Overview 619 Jerome Modell
Contents XXXI
12.2 Behaviour of Dead Bodies in Water 620 Jaap Molenaar
12.3 Search and Recovery in Near-Shore Waters 622 James Howe
12.4 Search Techniques 625
12.4.1 Search Techniques for Dead Bodies: Searching with Dogs 625 Adee Schoon
12.4.2 Search Techniques for Drowning Victims:
Recovery Using Side Scan Sonars 627 Robert Williamson
12.4.3 Infrared Detection Systems for Maritime Search and Rescue Units 630
Germ Martini 12.5 Homicidal Drowning 633
Andrea Zaferes and Walt Hendrick 12.6 The Approach of the Pathologist
to the Diagnosis of Drowning 636 Ian Calder
12.7 Accident Investigations in Drowning 640
Peter Cornall, Roger Bibbings and Peter MacGregor 12.8 Legal Aspects and Litigation in Aquatic Lifesaving 645
Jerome Modell
12.9 Legal Claims in Drowning Cases 647 Rutger Schimmelpenninck
12.10 The M/S Estonia Disaster
and the Treatment of Human Remains 650 Eke Boesten
12.11 Maritime Accident Investigations 653 John Stoop
Important Websites 659
Final Recommendations of the World Congress on Drowning 661 Acknowledgements 671
Contact Data and Affiliations 673
Subject Index 697
List of Contributors
Stathis Avramidis, MSc
European Lifeguard Academy Greece, El. Venizelou 12A,
18533 Kastella-Pireas, Greece Wolfgang Baumeier, Dipl. Ing, MD Department of Anaesthesiology, University Hospital Schleswig- Holstein, Campus Lübeck,
Ratzeburger Allee 160, 23538 Lübeck, Germany
Peter Barss, MD, ScD, MPH, DTMH, FACEPM, FRCPC
United Arab Emirates University Faculty of Medicine and Health Sciences,
PO Box 17666, Al Ain, United Arab Emirates
Steve Beerman, MD, BSc, BSR, CCFP, FCFP
Lifesaving Society Canada, 287 McArthur Avenue,
Ottawa Ontario, K1L 6P3, Canada Elizabeth Bennett, MPH, CHES Children’s Hospital and Regional Medical Center, Health Eduction, PO Box 50020/S-217, Seattle, WA 98145-5020, USA
Robert A. Berg, Professor, MD The University of Arizona College of Medicine,
1501 N Campbell Avenue, Tucson, AZ 85724-5073, USA
Roger E. Bibbings, MBE, BA, FIOSH, RSP
Royal Society for the Prevention of Accidents, RoSPA House,
Edgbaston Park, 353, Bristol Road, Birmingham B5 7ST, UK
Joost J. L.M. Bierens, Professor, MD, PhD, MCDM
Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117,
1081 HV Amsterdam, The Netherlands Jenny Blitvich, PhD
School of Human Movement and Sport Sciences,
University of Ballarat, Victoria 3353, Australia
Eke Boesten, LLM, PhD Celebesstraat 86, 2585 TP The Hague, The Netherlands
Leo L. Bossaert, Professor, MD, PhD University Hospital Antwerp,
Department of Intensive Care, Wilrijkstraat 10, 2610 Antwerp, Belgium
Alfred A. Bove, Professor, MD Cardiology Section,
Temple University Medical School,
3401 N. Broad Street, Philadelphia,
PA 19140, USA
Christine M. Branche, PhD National Center for Injury Prevention and Control, Centers for Disease Control and Prevention,
4770 Buford Highway NE, Mailstop K-63,
Atlanta GA 30431-3724, USA Helge Brandstrom, MD
Department of University Hospital, Anaesthesiology and Intensive Care, Umea, Sweden
Ruth A. Brenner, MD, MPH National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Room 7B03-7510, 6100 Executive Blvd, Bethesda, MD 20892-7510, USA
B. Chris Brewster
United States Lifesaving Association, 3850 Sequoia Street,
San Diego, CA 92109, USA Rob K. Brons, LLM Chief Fire Officer,
Fire and Rescue The Hague Region, PO Box 52158, 2505 CD The Hague, The Netherlands
Christopher J. Brooks, OMM, CD, MBChB, DAvMed, FFOM
Research & Development, Survival Systems Limited, Dartmouth, Nova Scotia, Canada David Calabria
D&D Technologies (USA), Inc., 7731 Woodwind Drive,
Huntington Beach, CA 92647, USA
Ian M. Calder, MD
University of Cambridge, Thorpe, Huntingdon Road,
Cambridge CB3 0LG, UK Jim Caruso, MD
1413 Research Blvd, Rockville, MD 20850, USA Davide Chiumello, MD
Istituto di Anestesia e Rianimazione, Universita’ degli Studi di Milano, Ospedale Maggiore Policlinico- IRCCS, Via Francesco Sforza 35, 20122 Milano, Italy
Veronique G.J.M. Colman, Professor, PhD
Faculty of Movement and Rehabilitation Sciences, Catholic University Leuven, Tervuursevest 101, 3001 Leuven, Belgium
Peter N. Cornall
Water and Leisure Safety,
Royal Society for the Prevention of Accidents, RoSPA house,
Edgbaston Park, 353 Bristol Road, Birmingham B5 7ST, UK
Günter Cornelissen, Dipl.Pol, Dipl.Ing
DIN Deutsches Institut für Normung eV, Verbraucherrat,
Postfach 301107, 10772 Berlin, Germany
Hein A. M. Daanen, Professor, PhD Department of
Performance & Comfort,
TNO Human Factors, PO Box 23, 3769 ZG Soesterberg,
The Netherlands
List of Contributors XXXV
Peter Dawes
Surf Life Saving Queensland, PO Box 3747,
South Brisbane QLD 4101, Australia Michel B. Ducharme, PhD
Human Protection and Performance Group, Operational Medicine Section, Defence Research and Development, 1133 Sheppard Avenue West, Toronto, Ontario, M3M 3B9, Canada
Glen Egstrom, PhD
University of California Los Angeles, Department of Physiological Sciences, 3440 Centinela Avenue, Box 951606, Los Angeles, CA 90095-1606, USA David H. Elliott OBE, Professor, MD, DPhil, FRCP, FFOM
40, Petworth Road, Rockdale, Haslemere, Surrey GU27 2HX, UK Mike Espino
American Red Cross National Headquarters,
8111 Gatehouse Road, 6th floor, Falls Church, Virginia 22042, USA Marit Farstad, MD
Department of Anesthesia and Intensive Care,
Institute for Surgical Sciences, Haukeland University Hospital, 5021 Bergen, Norway
Peter J Fenner AM, MD, DRCOG, FACTM, FRCGP
School of Medicine, James Cook University, Townsville, Queensland, PO Box 3080, North Mackay, Qld 4740, Australia
Adam P. Fischer, MD
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois,
Rue du Bugnon 46, 1011 Lausanne, Switzerland
Andrea Gabrielli, MD
Division of Critical Care Medicine University of Florida, 1600 Sw Archer Road, Gainesville, FL 32610-0254, USA
Luciano Gattinoni, Professor, MD, PhD
Maggiore Hospital, Department of Anesthesia and Intensive Care, Via F. Sforza 35, 20122 Milan, Italia Harry P.M.M. Gelissen, MD
Radboud University Medical Centre, Department of Intensive Care, PO Box 9101,
6500 HB Nijmegen, The Netherlands Gordon G. Giesbrecht, Professor, MD, PhD
211 Max Bell Centre, University of Manitoba,
Winnipeg, MB, R3T 2N2, Canada Julie Gilchrist, MD
National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention, Division of Unintentional Injury Prevention, 4770 Buford Highway NE, Mailstop K-63, Atlanta, GA 30341, USA
Frank St. C. Golden, MB, MD, BCh, PhD
15 Beech Grove, Gosport,
Hants PO12 2EJ, UK
Des Gorman, Professor, MD Occupational Medicine Unit, University of Auckland, Private Bag 92019, Auckland, New Zealand
Ralph S. Goto
Ocean Safety and Lifeguard Services Division, City and County of Honolulu, 3823 Leahi Avenue, Honolulu, HI 96815, Hawaii Shirley A. Graves, MD University of Florida,
College of Medicine, PO Box 100254, Gainesville, FL 32610, USA
Tom Griffiths, EdD Aquatics and Safety Office, Penn State University, Department of Intercollegiate Athletics,
University Park, PA 16802, USA Ivar Grøneng
Norwegian Maritime Directorate, PO Box 8123, 0032 Oslo,
Norway Ton Haasnoot
KNRM (Royal Netherlands Sea Rescue Institution),
PO Box 434, 1970 AK IJmuiden, The Netherlands
Katrina Haddrill
New South Wales Department of Tourism, Sport and Recreaction, PO Box 1422, Silverwater NWS 2128, Australia
Jack J. Haitsma, MD, PhD Department of Anesthesiology, Erasmus University Medical Centre, PO Box 1738, 3000 DR Rotterdam, The Netherlands
Anthony J. Handley, MD, FRCP 40 Queens Road, Colchester, Essex CO3 3PB, UK
W. Andrew Harrell, Professor, PhD Centre for Experimental Sociology, University of Alberta, 5-21 Tory, Edmonton, Alberta T6G 2H4, Canada Walter Hasibeder, MD
Department of Anesthesiology and Intensive Care Medicine, Krankenhaus der Barmherzigen Schwestern, Schlossberg 1, 4910 Ried im Innkreis, Österreich Balt Heldring, LLM
PC Hooftstraat 204, 1071 CH Amsterdam, The Netherlands Walter Hendrick
PO Box 548, Hurley, NY 12443, USA
Robyn M. Hoelle, MD Emergency Medicine, University of Florida, PO Box 14347,
Gainesville, FL 32604, USA James D. Howe Jr
Honolulu Emergency Services Department, Ocean Safety and Lifeguard Services Division, 3823 Leahi Avenue,
Honolulu Hawaii 96815
Paul Husby, Professor, MD, PhD Department of Anesthesia and Intensive Care, Institute for Surgical Sciences,
Haukeland University Hospital,
5021 Bergen, Norway
Ahamed H. Idris, Professor, MD Surgery and Emergency Medicine, University of Texas Southwestern Medical Center,
5323 Harry Hines Blvd, Dallas, TX 75390-8579, USA
Udo M. Illievich, Professor, MD Neuroanesthesiology and Critical Care, Clinic of Anesthesia and General Intensive Care, Medical University of Vienna, 1090 Vienna, Austria
Nicolaas J.G. Jansen, MD, PhD Pediatric Intensive Care Unit, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
Bas N. Jonkman, MsC
Delft University of Technology, Faculty of Civil Engineering, PO Box 5044, 2628 CS Delft, The Netherlands
Cor J. Kalkman, Professor, MD, PhD Division of Perioperative Care, Anesthesia, Emergency Medicine and Pain Management,
University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
Laurence M. Katz, MD University of North Carolina at Chapel Hill,
Department of Emergency Medicine, Neurosciences,
101 Manning Dr,
Chapel Hill, NC 27599, USA
List of Contributors XXXVII
